Preparing for exchanges: Key insights from states to help payers plan and operationalize

 

Health Benefit Exchanges (HBX), both public and private, present a new set of opportunities that health plans will need to evaluate.  The goals of HBX initiatives, to improve access to insurance and improve the quality of coverage while driving down price, are challenging to achieve under current operating models.  Payers need to review and revise their operational processes and IT infrastructure to successfully operate on exchanges. 

Only qualified health insurance plans will be allowed to offer coverage through state exchanges and must provide actuarially determined benefits that reflect state specific essential health benefits.  As rules and restrictions vary from state to state, health plans will need to carefully evaluate the steps needed to prepare to sell in the markets they operate. 

KPMG Healthcare has helped over 10 states in their HBX efforts and has created a payer target operating model that can help define effective ways to integrate key functions with the exchange.  

Join us on September 27, 2012 to hear KPMG healthcare provide an understanding of “how” HBXs will operate, what common principles among the states are emerging including trends among private exchanges, leading to a discussion of the payer specific exchange business architecture for payers to operate in the post reform environment. 

Speakers include: 

Joseph (Joe) Parente, Principal, KPMG

Paul Hencoski, Partner, KPMG

Mark Jamilkowski, Senior Manager, KPMG

 

Speaker Bios: 

Paul Hencoski
Partner, KPMG LLP

Paul Hencoski is KPMG’s National Health and Human Services Lead Partner for State and Local Government and the Global Chair for Human and Social Services. He focuses on coordinating the analysis of national trends, development of methodologies, and delivery of services in the health and human services domain. He is experienced with Medicaid, TANF, SNAP, Child Welfare, Child Support, and Subsidized Child Care programs.

Paul oversees KPMG’s engagements with the States of New Jersey, Connecticut, and Rhode Island assisting with Health Benefit Exchange planning. He also advises on services provided to the CIO of the City of New York’s Office of Health and Human Services’ HHS-Connect program. Prior to joining KPMG, Paul was a principal with a major government systems integrator. Paul has a Bachelor of Arts in economics and political science from the University of Rochester and holds certificates in Management Studies and International Relations.

Paul is a member of several professional organizations, including the American Public Human Services Association (APHSA), National Child Support Enforcement Association (NCSEA), American Management Association (AMA), and Project Management Institute (PMI). He is a Certified Project Management Professional.

 

Mark Jamilkowski
Senior Manager, KPMG LLP

Mark is a Director in KPMG’s Health Actuarial Services Practice. Mark has over 25 years of experience in actuarial analysis and financial planning involving U.S. healthcare insurers and providers.  Mark has direct experience with financial management reporting and key performance indicators, process benchmarking and redesign, product pricing and experience monitoring, actuarial valuations, and analytics supporting provider contracting particularly around accountable care.  Mark has also been assisting states evaluate and implement Benefit Exchanges, and chairs the American Academy of Actuaries Health Insurance Exchange Task Force. 

 

Joe Parente
Principal, KPMG LLP

Joe is a Principal in KPMG’s Healthcare Advisory Services practice and has more than 20 years of management consulting and technology experience with a focus on managing strategy, transformation and technology innovation initiatives for health plans and life sciences companies.  

Joe serves as the lead for KPMG’s national health insurance practice.  In this role he is responsible for performing industry research, providing thought leadership, and setting strategic direction for KPMG’s health insurance practice.  

Joe continues to advise C-level executives in the Healthcare industry, and serves as a member of KPMG’s National Healthcare Advisory Board which is comprised of external senior industry executives and KPMG senior partners from the Healthcare and Pharmaceutical sectors.

 

The content presented in this webinar is solely attributable to the speaker and does not represent an endorsement by America's Health Insurance Plans (AHIP) of the accuracy of the information presented in the audio conference or any opinion expressed by the speaker.